AccountId: 011433970860
ContactId: 233d657b-601c-47fe-b747-1191f9bb16fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263049 ms
Total Talk Time (AGENT): 125561 ms
Total Talk Time (CUSTOMER): 87491 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/233d657b-601c-47fe-b747-1191f9bb16fc_20250205T14:46_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm sorry, what was your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Hi, so, my name is [PII]. The initial of my last name is [PII]
[CUSTOMER][NEUTRAL] And I'm calling just to get benefits. I need the in and out of network benefits please for um patient [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, sure, I can assist you with benefits, Miss [PII]. Um, may I have a callback number just in case we get disconnected and where are you calling from?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I'm calling from um hold on just a moment.
[CUSTOMER][NEUTRAL] Hi, I'm calling from Doctor [PII]'s office here in [PII].
[CUSTOMER][NEUTRAL] And my callback number is [PII] and that's the direct line.
[AGENT][NEUTRAL] Thank you. May I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Ma'am, I have.
[CUSTOMER][NEUTRAL] 02475721
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII]'s date of birth is [PII].
[AGENT][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] All right. And you said you need benefits and you need to know if it's in network or out of network, correct?
[CUSTOMER][NEUTRAL] Yeah, I just need to get deductible and um all that just.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, uh, what type of service, this is an office visit, um, for office procedures or it's just the office visit itself?
[CUSTOMER][NEUTRAL] It's for um.
[CUSTOMER][NEUTRAL] Outpatient surgery, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It is this gonna be an office setting or outpatient facility?
[CUSTOMER][NEUTRAL] Outpatient hospital.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, thank you. All right, and um before I give you any benefit information, I need to let you know that this is not a guaranteed payment, just a verification of coverage and that's just a disclaimer. And this is one of our hospital indemnity plan. It is a limited plan. Um, it is not a major medical, so there's no deductibles, co-payment or co-insurance. Um, this pays a flat amount.
[AGENT][NEUTRAL] Let me go ahead and give you that.
[CUSTOMER][NEUTRAL] No deductible and no coinsurance.
[AGENT][NEUTRAL] No, because it's not a major medical, so it just pays a flat amount an indemnity amount.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And for this one we have.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, calendar year maximum of 2000 per covered person per calendar year for surgery. Now, this one only covers the surgeon, um, charges and the anesthesiologist.
[AGENT][NEUTRAL] So it's for this
[CUSTOMER][NEUTRAL] I'm sorry, you, you keep breaking up for some reason. It covers the surgeon and what?
[AGENT][NEUTRAL] I'm sorry. Surgeon and um anesthesiologist.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So it doesn't cover the facility charges.
[CUSTOMER][NEGATIVE] Does not cover facility charges.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And um you said about the network if the provider participates with multi plan they get that additional discount but it is not required, we're not contracted.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so no deductible, no co-insurance, uh, hospital indemnity plan, cover surgeon and an anesthesiologist, no facility charge. It does not cover facility charges.
[AGENT][NEUTRAL] Correct. And the maximum amount is up to $2000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] Up to 2000 max.
[CUSTOMER][NEUTRAL] Per year.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty
[AGENT][NEUTRAL] OK. Is there anything else I may help you with today, Miss [PII]?
[CUSTOMER][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEUTRAL] No ma'am, that's everything.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Thank you bye bye.